Keep Your Child Safe

All kids have to visit the dentist. And many will need to undergo painful procedures, for which they'll need sedation or anesthesia. How can you ensure that your child gets the safest treatment possible?

We talked to Dr. Myron Yaster, an expert on pediatric pain management. Dr. Yaster is an anesthesiologist, a pediatrician, an associate professor of anesthesiology, critical care medicine and pediatrics at Johns Hopkins University, as well as the author of a widely used handbook on how to safely and effectively sedate and anesthetize kids.

Dr. Yaster also has first-hand experience as a worried parent. Last month, his own son was sedated during oral surgery to remove an extra tooth. (The dentist followed correct procedures, and there were no complications.)

Here are some of Dr. Yaster's tips:

• Dr. Yaster emphatically believes that sedation and anesthesia have a place in dentistry, especially with children, who may be impossible to operate on otherwise. He argues that when dentists follow proper procedures, there aren't any problems. "It's when they fail to follow guidelines that they get into trouble," he says. "Doctors must have a healthy respect for these guidelines and the drugs that they're using. Sometimes, they lose that respect: You get away with it, you get away with it, you get away with it. Then a catastrophe happens."
• Many parents instill in their children a dread of going to the dentist. This can exacerbate any anxiety they may already feel. Emphasize to your kids that visiting the dentist is not something to be afraid of. They'll tend to be less nervous, and the question of whether or not to use sedation or general anesthesia may not even come up.
• Start taking your child to the dentist at a young age so that he or she will not enter the dentist's office for the first time with severe dental problems. This way, there will be less chance that a serious and possibly painful procedure will be necessary.
• If a dentist or oral surgeon wants to put your child under, ask him or her about the qualifications of the person who's will provide sedation. There should be someone whose sole job is to monitor the unconscious patient. So there must be at least two people attending the operation. This person must know how to resuscitate someone, understand the drugs involved in the procedure, and know how to use the equipment involved. Ask the dentist if this person has experience with advanced pediatric life support and advanced trauma life support.
• Will monitoring devices be used in the operation? The dentist should minimally have a pulse oximeter, which measures how much oxygen is in the bloodstream. He or she should also have an EKG machine, which measures heart rate, and a device that measures blood pressure.
• Another question: Is there a facility to take care of patient until recover? Just because the surgeon is done doesn't mean the procedure s over. Until the patient returns to pre-sedation level of consciousness, monitoring must continue.
• Does the dentist ask you to sign a consent form for sedation? If not, this is a "red flag," Dr. Yaster says. "If there's no consent form, that usually means they're just blowing the whole thing off."
• Before any procedure involving sedation or anesthesia, the dentist should do a physical examination. Even an apparently healthy child may have health problems, asthma for example, that could complicate the operation.

written by David Kohn